Quality Assurance

An Introduction For Healthcare Professionals

Contents:
Unit one: Understanding (1)Introduction to understand quality. quality (2)Quality. (3)Quality Assurance. Unit two: Assessing and (4) Introduction Assessing and improving Quality. improving (5) The steps in Quality appraisal. (6) The steps in Quality action Following the steps Unit three: Looking to the (7) Introduction to following the steps: A clinical Scenario future Unit four (8) Aim and objectives Reviewed

Unit one:

1 Introduction

Introduction to understanding Quality

Quality is a word that is commonly used both in work environment and in home setting. But as a concept quality is hard to define. To help you understand quality consider the following questions: -What is quality? -Whose business is quality? - How is quality judged? -Who set the quality standard?

Quality

What is quality?

*apple and car In an apple example, color, taste, size, ouder, price, etc.. * In your specification of your quality car include:reliability, safety, durability, purchase cost, running cost, maintenance, styling, color The business person car's need to be -expensive, comfortable -powerful, reliable, etc

These examples we used of an apple and car have shown that is quit easy to list features that describe the quality of given product.. It is more difficult to describe quality in relation to healthcare. Health care is a mix of services ranging from health promotion to organ transplantation. Quality of care involves both the technical aspects of providing service and human aspects which arise from the personal contact between the supplier and receiver of care.

Whose the professional practitioner in your field?

Probably you used words like: Committed, caring, communicable Accountable, autonomous, approachable Reliable, respected, resourceful Expert, efficient, ethical * These trait describe someone's ability as a component practitioner, but they dont describe the service that is provided.

The following are some features that you might include if you were asked to describe a quality service in your own area of expertise Comprehensive, cost-effective, contractual Accessible, accredited, acceptable Relevant, reliable, resourced Efficient, equitable, effective

Whose business is quality?

Returning to the apple example:

supplier supplier supplier supplier

Grower

Distributer

Wholesaler

Retailer

You

customer

This situation is more complex in health care

Diagram 1

The total quality focus

society

society

clients

Diagram 2 society Quality is shown as central focus of attention for practitioners, managers, and client

society

Quality is everyone's business

Achieving Quality care:

Client
Community health council Pressure group media

Professional

Quality care

Management

Other

Diagram 3

There is a potential problem since the quality is every one's business it can become no one's business. There fore, in any organization or business, someone need to take responsibility for quality. Perhaps this person is a member of management board or a senior member of your professional group

How quality is judged?

In health care quality is judged against standard. Here is the college of occupational therapist's definition:

A standard is an acceptable or approved example or standard of

something which measurement and/or judgment takes place; a level of quality relevant to activity.

There are many important point in this definition. A standard: (1) Specifies what is important to achieve (2) Specifies levels that have to be achieved (3) May apply to an activity or feature that is important for quality. (4) May apply to series of activities or a collection of feature that are important for quality.

Example: (of a standard)

95% of clients at an outpatients clinic are seen by the consultant no later than 20 minutes after their scheduled appointment time. actual achieved performance is measured against identified quality criteria. This is used to judge whether the standard is being met. If our example record show that 30% of client wait longer than 20 minute after scheduled appointment, then the standard is not being met. Managers can deal with situation by two ways: (1) changes could be implemented in the service to enable the standard to be met (quality improve). (2) it may be decided that the target is unachievable within existing resource availability and the standard.

Quality frame work Various framework can be used in describing quality. In an early attempt to measure health care quality, (!)Donabedian(1966) :proposed three categories into which service could be characterized structure, process and outcome: - structure: include personnel, equipment, buildings, record systems, finance, supplies and facilities; -process: incorporates all aspects of the performance of activities of care. -outcome: denotes the end results of care/service. All three categories need to be considered to obtain view a balance of quality.

(!!)Industrial (Juran 1988, Maxwell, 1984)

Timeliness: including access, waiting and action time Information: clarification by answering what, why, when, how, who; Technical competence: including medical knowledge, skills and expertise; ethics, technology, completeness and success of treatment. Personnel interaction with practitioner/clients: including courtesy, respect, beside manner; Environment: including buildings, cleanliness, amenities

Who sets the standards?

consumer NHS clients Accreditation committees practitioner management DOH Professional bodies WHO government

Diagram 4

Standard:
Every individual who accepts that quality is everyones business sets personal standard, both in their professional and private roles. These personal standard are informal and are seldom written down or seen by any one else. Individual judge their own performance against their own determined specifications. The client is on the receiving end of care therefore clients view of the service is very important. Clients set informal standard on the quality of care that they except to receive. They can directly influence formal standard setting through various consumer bodies and pressure groups. Many studies performed over the last10 years have investigated clients objectives opinions. Practitioners are involved in setting standards for the care of individual clients. Standard for client care should be set within interprofessional teams-taking an holistic approach to client care. All of these standards must be comply with the standards of care specified by the professional bodies that

express their agreed codes of conduct and philosophies of health care.

Local management will set standard that specify local commitment to quality and reflect local needs. This standard should be within the framework of the standard set by regional health care Authorities. The out line of these example standards is based on the Dynamic Standard Setting System (DySSSy) (RCN, 1990), which will be discussed in unit two.

***** Example standard (in the book p23-25) **** self assessment Questions p26-29 *****

3 Quality Assurance

We have to consider the following questions:

What is quality assurance? Why is quality assurance? How has quality assurance evolved in UK? What does quality cost? How do you find out about quality assurance?

What is quality assurance? Quality assurance is an integral part of client care activities in all health Authorities. Its objective it is to improve the care provided to clients. No simple or unique definition of quality assurance.

Quality is the effective execution of all the activities concerned with attaining quality . It provides objective evidence that gives client and society confidence that the quality of care within an institution satisfies stated requirements. This the level of guarantee.

At a basic level, quality assurance incorporates the following stages( Lang, 1984): Setting standards. Appraising actual achievement. Planning for improvement. Taking action when required. *setting standard involve writing statements that describe achievable and desirable level of quality of car. These are professionals expectations of the service and statement of intent of clients. Appraising actual achievement involves comparing practice with the defined standards through measuring criteria. Any gap b/w provision and expectation requires action. This involves planning for improvement. If quality is below the stated acceptable level, then action is taken to raise quality until standard met.

Quality assurance is a continuous process. Comparison is made periodically which enables effects of change to be monitored.

A basic quality wheel:

act Set standards

plan appraise

Quality assurance is never ending improvement in the quality of care.

Quality spiral

In order to be successful, it is obvious that quality assurance must be organized and managed through a structured system. The coordination of quality assurance system is the overall responsibility of management. Such system ensure that the quality assurance actually takes place within an organization and that all activities are documented and reported.

what is needed to support quality assurance

There ought to be ticks against each feature. Clear, detailed and accurate records need to be maintained on procedures to be followed, action to be taken and action actually taken. Effective communication at all levels of the organization means that people are well informed. Training programme keep personnel up to date with skills and technical developments. To management needs to be committed so that resources allocated to quality assurance initiatives and actions are followed through. People need to know what they expected to do so responsibility for quality activities must be clearly assigned.

Why quality assurance is needed in health care?

There are many factors

Professional factors
Codes of conduct Growth of autonomy Accountability Economic factors Demographic change Resource distribution

Social/political factors Public a wereness Social expectations

Legislation
Accreditation International pressure

Interprofessionalism
Moral issues

Professional factors: Code of conduct: each profession has a code of conduct or statement about professional behaviour which out line professional rules. Growth of autonomy and accountability: in recent years professionals have taken increasing responsibility for their own practice. This has highlighted commitment to a consistent and accountable service-a major aim of quality assurance. Interprofessionalism: a quality service to clients often demands an interprofessional approach. This means that communication b/w the professional must be effective and efficient. Such communication is an integral part of quality assurance.

Economic factors: Demographic change: changing demography compels the adoption of quality assurance in health care. Resource distribution: the national health service in Britain. It accountable for both the service it provides and the resources it uses. Social/ Political factors: Public awareness: pressure from society is creating the need for more efficient health service. Social expectation: changing social expectation are another reason for quality assurance in health care. There is a growing number of consumer bodies which campaign for rights of individuals or groups.

Legislation: the law clearly has a voice in maintaining

standards in heath care. Many minimal standards for practice are already agreed in law and part from quality assurance programmes of health personnel. Accreditation: in Britain, private nursing homes need a licence to operate and are inspected by officer. International pressure: the international political forum also has its effect on the health service. As a member of the world health organization, Britain was committed to the devolvement of quality assurance systems health by 1990.

How has quality assurance evolved in the U.K?

The need for quality considerations was highlighted during world war 1, when failure of British aircraft engines behind enemy lines resulted in the loss of trained pilots. The change in quality focus from inspection to the more efficient and costeffective approach of structuring and managing a system for product quality took decades.

What does quality cost?

Costs are an important factor in any business or organization and health care is no exception. In general, cost are identified and recorded with respect to the performance of various function, for example specific categories of treatment, clerical assistance, building maintenance, laundry services. Quality related costs are often hidden or scattered among various accounts. It is useful to adopt the industrial distribution b/w costs incurred through a lack of quality or poor service, and costs incurred to provide and monitor a quality service (Juran, 1988);

Cost of lack of quality:

Failure costs: Failure cost are due to not doing the right thing right place at the right time. We need to add to this, in the right way and by the right personnel. This include: (1)Not meeting agreed standard of care. (2)Setting standards inappropraite to client need; (3)Setting standard that allows a client to receive incompatible treatment from different preofessionals; (4)Treating conditions that are capable of detection at an earlier stage of development whent treatment costs and client costs would be lower. ..etc

Utilization costs:
Utilization costs are incurred when resources are not used efficiently and effectively; (1) Inappropriate of skills such that personnel are given tasks inconsistent with their ability, training and experience; (2) Under-utilization of personnel and equipment that resulting the potential quality of care not being reached. (3) Over-utilization of materials and drugs resulting in excessive costs and waste; (4) Over-utilization of personnel due to unnecessary appointment, unnecessary tests and treatment, etc (5) Over-utilization of equipments such that is poorly maintained and infrequently calibrated * Loss in morale and loss in goodwill are controversial quality costs that arise when practitioner expectation of the system or organization are not satisfied.

Appraisal costs:

Appraisal cost are incurred by administering a mongering system that appraises and assesses the quality of care. Some appraisal techniques are discussed in unit two.

prevention costs:
Prevention cost are incurred performing activities that are aimed keeping failure and appraisal costs to a minimum. These activities include: -development and maintenance of quality system; -development and improvement of standard; -educating personnel about quality; -providing continuing training of personnel. *theoretically, the cost of implementing a quality assurance system should be outweighed by the resulting saving s through improved efficiency, effectiveness and client satisfaction.

How do you find about quality assurance?